Why Does Your Heartburn Always Seem Worse at Night?

Tips for reducing nocturnal heartburn
woman with heartburn at night

You get it after you eat spicy food. You even get it when you wear tight pants and belts. If you suffer from heartburn, you know that burning sensation in your chest is always unpleasant. But you may wonder why it often seems worse when you’re trying to get some sleep. Why is it more likely to flare up at night?

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Blame it on the natural force of gravity. It doesn’t work in your favor when you’re lying down. When you sit or stand, gravity helps move your food through the esophagus and into the stomach where digestion occurs.

“When you’re lying down, you lose gravity’s help in allowing your esophagus to clear food, bile and acids,” says gastroenterologist Scott Gabbard, MD. “That can allow for heartburn to happen.”

While every person’s experience with heartburn is a little different, most people have heartburn symptoms during the day and at night. However, many find it tougher to control at night.

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What causes this burning sensation?

When you eat, food passes down your throat and through your esophagus to your stomach. A muscle (the lower esophageal sphincter) controls the opening between the esophagus and the stomach. It remains tightly closed except when you swallow food.

When this muscle fails to close after food passes through, the acidic contents of your stomach can travel back up into the esophagus. Doctors refer to this backward movement as reflux. When stomach acid hits the lower part of the esophagus, it can produce a burning sensation. This is what we call heartburn or, more formally, gastroesophageal reflux disease (GERD).

“About one in 10 adults has heartburn at least once a week, and 1 in 3​ have it every month,” says Dr. Gabbard. “About 10 to 20% of adults have chronic heartburn.”

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Tips to reduce nighttime heartburn

Dr. Gabbard recommends these steps you can take to reduce heartburn:

  • Lose weight. Body mass index (BMI) takes weight and height into account. People who are overweight (BMI of 25 or above) are at a greater risk for heartburn.
  • Stop smoking. Quitting smoking is one of the most important things you can do to help reduce heartburn. One study found that when 141 patients quit smoking, their GERD improved by 44%. However, the 50 people who didn’t quit smoking only saw an 18.2% improvement in their GERD. Quitting tobacco not only does wonders to alleviate heartburn, but it also helps you in other areas of your health.  
  • Eat smaller, less fatty meals, especially later in the day. For someone with chronic heartburn, a meal of less than 500 calories and 20 grams of fat is ideal.
  • Wait at least three hours after eating to go to bed. It takes the stomach four to five hours to fully empty a meal, so give it at least three hours.
  • Try acid-reducing medications. The most commonly prescribed medications for GERD are proton pump inhibitors. While thought to be generally safe, patients with long-term use of these medications should discuss potential risks with their doctors.
  • Try alginate preparations. If you need a medication to take on-demand, consider trying a preparation containing alginate. Alginate has been shown to form a raft on top of the pocket of acid that sits in the stomach. It’s been shown to be an effective agent when taken on an as-needed basis.
  • Keep food sensitivities in mind. Avoid foods that may trigger digestive problems like tomatoes, lemons, dairy products or even alcohol. 
  • Use a wedge pillow at night. Dr. Gabbard recommends using a wedge pillow or sleep-positioning device that helps keep you on your left side with your head elevated. Lying on your left side allows acidic contents to pass through the lower esophageal sphincter into the stomach. Plus, elevating your head allows gravity to work.

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